Silke F Metzelthin

• PhD
• PostDoc Position at Maastricht University

Reablement: meeting the challenges facing dementia services Dementia is a major cause of disability. People with dementia need good support, but health and social care services are overstretched and cannot provide all the support people need. Progress with drug treatments and preventive measures will not be enough to solve the problem. We need effe...

Dementia is a major cause of disability. People with dementia need good support, but health and social care services are overstretched and cannot provide all the support people need. Progress with drug treatments and preventive measures will not be enough to solve the problem. We need effective non-pharmacological approaches to reduce disability fo...

The World Health Organization (WHO) recognizes the right of individuals with dementia and their family caregivers to access interventions that enhance their participation in society. Reablement is an approach that enables older people to participate in meaningful daily and social activities. Over the past decade, a growing body of evidence has unde...

Background Goal setting is an essential component of reablement programmes. At the same time it is also an important aspect in the evaluation of reablement from the perspective of clients. Objectives As part of the TRANS-SENIOR project, this research aims to get an in-depth insight of goal setting and goal attainment within reablement services fro...

Reablement is considered a complex intervention due to its multicomponent, person-centered, holistic approach promoting older adults’ active participation in daily activities. It is important to consider the unique context in which complex interventions are implemented, as contextual factors may interact and influence implementation outcomes. As pa...

Purpose Over the last two decades, reablement programs have been studied and implemented internationally. Goal-setting and multidisciplinary collaboration are central elements of reablement. Unfortunately, limited intervention descriptions leave questions on how they are applied in practice and how goals set by the user are achieved. As a consequen...

Over the last two decades, reablement has been studied and implemented in more than 16 countries. It is a person-centred approach aiming to enhance individuals’ (physical) functioning and increase or maintain their independence in meaningful activities. Goal setting and interdisciplinary collaboration are identified as important key elements of...

Demand for long-term care is rising, because of the aging of the population and the increase in chronic and degenerative diseases. Both community and institutional care services are facing challenges, not only caused by aggregated care needs but also through technological and related health care innovations. At the same time, the number of well-tra...

Introduction: Reablement promotes independent living among older people by, amongst other strategies, involving their social network. However, previous studies have shown that next of kin are seldom involved in the reablement process, and when they are, they are insufficiently supported, often resulting in a higher experienced burden. Little is kno...

In the Netherlands, reablement is high on the agenda for inclusion in future health care policy, resulting in more and more care providers wanting to implement reablement into their everyday practice. So far, it has been implemented, resourced and organized in multiple ways. To support the implementation on an (inter)national level, insight is need...

With an increasing age, people are at risk for functional decline and care dependency. Frail older people in any site of care –at home, in nursing homes and in acute care– are supported by nursing staff to optimize their functioning, remain active, and maximize their independence. However, nursing staff often tend to work in a task-oriented manner...

For frail older people it is evident to maintain their functional abilities and independence. Nursing staff are in a key position to encourage older people’s independence and stimulate their engagement in functional activity. However, nurses tend to take over tasks frequently thereby depriving older people’s remaining abilities. Clearly nurses need...

The concept of aging-in-place has become increasingly popular worldwide, including the Netherlands. However, as individuals age, their ability to perform activities of daily living often declines leading towards a need for homecare. Unfortunately, staff often unnecessarily take over care tasks and thereby potentially accelerate older adults’ functi...

Background Reablement is a person-centered, holistic approach promoting older adults’ participation through social, leisure, and physical activities. Family caregivers are seldom involved in reablement services despite their wish to be an active member of the care team and expressing a need for more support and recognition. The voice of family care...

Numerous countries have been developing a reablement approach for several years. However, the stage of implementation, as well as the scaling up, differs across each country. The aim of this chapter is to consider key issues relating to the implementation of reablement to determine the shared issues for development, refinement, and spread. The chap...

This chapter looks at the evidence regarding the effectiveness of reablement for older people themselves. The most commonly examined client-level outcomes are daily functioning, physical function and quality of life. The evidence relating to each of these is described in separate sections, while that pertaining to less commonly used measures is des...

Objectives As age increases, people generally start experiencing problems related to independent living, resulting in an increased need for long-term care services. Investing in sustainable solutions to promote independent living is therefore essential. Subsequently, reablement is a concept attracting growing interest. Reablement is a person-centre...

Introduction: Supporting care receivers in Activities of Daily Living (ADL), irrespective of diagnosis, setting, or cultural background, lies at the heart of fundamental nursing care. The pursuit of quality ADL care becomes increasingly challenging with the changing complexity of care needs. ADL care delivery is often undervalued and is considered...

Despite its frequent provision, evidence of nursing interventions in Activities of Daily Living (ADL) remains unclear. Hence, we addressed the research question: What are the effects of ADL nursing interventions on independence and comfort in adults across all care settings? We conducted a systematic review of randomized controlled trials and quasi...

Background Care for activities of daily living (ADL) performed by nursing professionals is poorly informed by scientific evidence. To address the nursing professionals’ need for guidance, we developed a clinical practice guideline on ADL care. This guideline comprises key recommendations (KRs) on involving care receivers and informal caregivers in...

Numerous countries have been developing a reablement approach for several years. However, the stage of implementation, as well as the scaling up, differs across each country. The aim of this chapter is to consider key issues relating to the implementation of reablement to determine the shared issues for development, refinement, and spread. The chap...

This book introduces reablement, a radical new integrated care approach which seeks to empower older people to regain and maintain functioning and independence.

This book introduces reablement, a radical new integrated care approach which seeks to empower older people to regain and maintain functioning and independence.

Nursing care in activities of daily living (ADL), such as washing, dressing, or eating is frequently provided while being poorly informed by scientific evidence. To address nursing professionals’ need for guidance we developed a practice guideline on ADL-care. This guideline comprises eleven core recommendations on involving care receivers and info...

Aim: To identify personal beliefs of Dutch nursing staff about encouraging psychogeriatric nursing home residents in daily activities. Design: Qualitative study following COREQ guidelines. Methods: Fifteen semi-structured interviews with Dutch nursing staff of wards hosting psychogeriatric residents were conducted in Spring 2021. Data were sys...

Background Reablement services are intended to make a difference in the daily lives of older adults. Outcomes are often described in terms of independence, improving quality of life, improving ADL functioning, or reducing services. However, little is known if the older adults or next-of-kin experience these outcomes when talking about participating...

Background Nurses are in a key position to stimulate older people to maximize their functional activity and independence. However, nurses still often work in a task-oriented manner and tend to take over tasks unnecessarily. It is evident to support nurses to focus on the capabilities of older people and provide care assistance only when required. F...

Unlabelled: This systematic review aimed to provide an overview of reablement interventions according to the recently published ReAble definition and their effect on Activities of Daily Living (ADL). In addition, the most common and promising features of these reablement interventions were identified. Four electronic bibliographic databases were s...

Background Case-mix based prospective payment of homecare is being implemented in several countries to work towards more efficient and client-centred homecare. However, existing models can only explain a limited part of variance in homecare use, due to their reliance on health- and function-related client data. It is unclear which predictors could...

[This corrects the article DOI: 10.1007/s10433-021-00668-w.].

The COVID-19 pandemic has severely affected healthcare delivery across the world. However, little is known about COVID-19’s impact on home healthcare (HHC) services. Our study aimed to: (1) describe the changes in volume and intensity of HHC services and the crisis management policies implemented; (2) understand the responses and the experiences of...

Ageing with a disability increases the risk of hospitalization and nursing home admission. Ageing in place interventions aiming to reduce disability are often not sufficiently effective and inadequately theory-based. There are many models available on disability, but it is unclear how they define disability, what their differences are, and how they...

Training and supporting homecare staff in reablement aims to change staff behavior from “doing for” to “doing with” older adults, i.e., supporting client activation. We evaluated the effectiveness of the reablement training program “Stay Active at Home” (SAaH) on staff self-efficacy and outcome expectations regarding client activation in a cluster...

Purpose Training and supporting homecare staff in reablement aims to change staff behavior from “doing for” to “doing with” older adults and is assumed to benefit the health and quality of life of older adults and reduce healthcare utilization and costs. This study evaluated the cost-effectiveness and cost-utility of the staff reablement training p...

This systematic review, guided by the ReAble-definition, (1) provides an overview of reablement interventions and their effect on Activities of Daily Living (ADL), and (2) identifies common features of effective interventions. A systematic search was conducted from 2002 to 2020, identifying nineteen studies from eight countries with a total of 6,53...

Reablement encourages older adults to do things themselves rather than having things done for them. To implement reablement in practice homecare staff needs the right knowledge, attitude, skills and support. This study evaluated the effectiveness of the “Stay Active at Home” reablement training program. A 12-month cluster-RCT was conducted, involvi...

Patients returning home after geriatric rehabilitation may encounter several challenges related to daily functioning, which only manifest after returned home due to the large difference in environment and amount of support provided in both settings. This study aimed to develop an intervention preventing transitional care. A co-creation design was u...

Supporting and respecting care receivers in Activities of Daily Living (ADL) lies at the essence of nursing care, irrespective of diagnosis or healthcare setting. ADL-care is an intimate form of caring, and therefore close and personal to the care receiver, aiming to enhance their independence and comfort. Even though ADL-care is indispensable and...

Function Focused Care (FFC) interventions support nurses to adapt their level of care to the capabilities of older people and to optimize their self-reliance. Recently, three FFC-interventions were implemented in various Dutch care settings. Lessons learned and implications were synthesized and an advanced FFC-program ‘SELF’ was developed for wide...

Background and Objective: Function-Focused Care (FFC) aims to optimize daily functioning of older people by changing clinical nursing practice of care professionals. Recently, three multicomponent FFC-programs were implemented in the Dutch home, nursing home, and hospital care setting. Process evaluations were conducted including eight focus groups...

Background : During hospitalization patients frequently have a low level of physical activity, which is an important risk factor for functional decline. Function Focused Care (FFC) is an evidence-based intervention developed in the United States to prevent functional decline in older patients. Within FFC, nurses help older patients optimally partic...

Background The Nurses in the Lead (NitL) programme consists of a systematic approach and training to 1) empower community nurses in implementing evidence, targeted at encouraging functional activities of older adults, and 2) train community nurses in enabling team members to change their practice. This article aims to describe the process evaluatio...

Background/objectives: Homecare staff often take over activities instead of "doing activities with" clients, thereby hampering clients from remaining active in daily life. Training and supporting staff to integrate reablement into their working practices may reduce clients' sedentary behavior and improve their independence. This study evaluated the...

Purpose This study aims to provide a detailed description of the nurses in the lead (NitL) programme for empowering community nurse leadership in implementing evidence. Design/methodology/approach The NitL programme is described using the template for intervention description and replication-checklist. Findings The NitL programme consists of two...

Aims and objectives: To identify the nurses' perceptions of their role with respect to promoting physical activity in adult patients and factors related to this role perceptions. Background: Ageing and chronic diseases are often accompanied by a decrease in physical activity. Nurses are in an excellent position to promote physical activity, beca...

Self-efficacy and outcome expectations regarding client activation determine professionals’ level of actively engaging clients during daily activities. The Client Activation Self-Efficacy and Outcome Expectation Scales for nurses and domestic support workers (DSWs) were developed to measure these concepts. This study aimed to assess their psychomet...

Background Many community-dwelling older adults experience limitations in (instrumental) activities of daily living, resulting in the need for homecare services. Whereas services should ideally aim at maintaining independence, homecare staff often take over activities, thereby undermining older adults’ self-care skills and jeopardizing their abilit...

Background Communication between nursing staff and people with dementia can be challenging. According to the literature, communication is seen as a process of social- and/or informational exchange between a sender and a receiver in a context. Factors related to these elements determine the quality of communication. Insight into the factors involved...

In recent years, Function Focused Care (FFC) interventions have been developed and implemented in Dutch home care, nursing homes and acute care. These interventions aimed to train nursing staff to adapt their level of support to the capabilities of elderly and to maintain/optimize their self-reliance and physical functioning. After synthesizing kno...

Stay Active at Home (SAaH) was developed to change homecare professionals’ behavior towards encouraging older adults’ independence in daily activities. This mixed-methods study evaluated SAaH regarding implementation, mechanisms of impact, and context. SAaH was implemented in five Dutch homecare teams (162 professionals). Quantitative data were col...

Functional decline in older adults often lead towards acute or long-term care. In practice, caregivers often focus on completion of care tasks and of prevention of injuries from falls. This task based, safety approach inadvertently results in fewer opportunities for older adults to be actively involved in activities. Further deconditioning and func...

Many hospitalized patients experience decline in functional status. Function Focused Care (FFC) has demonstrated to improve patients’ functional status in long-term care. In a stepped wedge cluster trial in 893 hospitalized geriatric and stroke patients, we investigated the effectiveness of FFC compared to usual care (FFC: n=427, UC: n=466) on ADL...

Background The Netherlands is currently investigating the feasibility of moving from fee-for-service to prospective payments for home healthcare, which would require a suitable case-mix system. In 2017, health insurers mandated a preliminary case-mix system as a first step towards generating information on client differences in relation to care use...

Background: Community care professionals need to encourage older adults in performing functional activities to maintain independence. However, professionals often perform functional activities on behalf of older adults. To change this, insights into the behavior and barriers of professionals in encouraging activities are required. In the current s...

With an ageing society, the demand for health and social care is increasing. Traditionally, staff provide care for their clients rather than with them. In contrast, reablement aims to support people to maximise their competences to manage their everyday life as independently as possible. There is considerable variation between and within countries...

Patients often experience a functional decline due to physical inactivity during illness. Nurses can influence the physical activity of patients while assisting them with activities of daily living. The purpose of this study was to identify effective interventions that are embedded in daily nursing care (irrespective of care setting) that aim to op...

Introduction Compared with fee-for-service systems, prospective payment based on casemix classification is thought to promote more efficient, needs-based care provision. We aim to develop a casemix classification to predict the costs of home care in the Netherlands. Methods and analysis The research is designed as a multicentre, cross-sectional co...

Background: Case-mix based payment of health care services offers potential to contain expenditure growth and simultaneously support needs-based care provision. However, limited evidence exists on its application in home health care (HHC). Therefore, this study aimed to synthesize available international literature on existing case-mix models for...

In shared decision making, the exploration of preferred personal health outcomes is important. Patient-reported outcome measures (PROMs) provide input for discussions between patients and healthcare professionals. The Older Persons and Informal Caregivers Survey Minimum DataSet (TOPICS-MDS) PROM is a multidimensional questionnaire on the physical a...

Activities of Daily Living are a series of basic activities performed by individuals on a daily basis necessary for independent living at home or in the community. ADL are part of basic nursing care which describe aspects of care that are fundamental to all patients’ health and well-being, regardless of diagnosis, cultural background or healthcare...

To face the challenges of an ageing population, many Western countries nowadays stimulate an ageing in place policy to empower older adults to grow old in their own homes with the highest degree of self‐reliance. However, many community‐living older adults experience limitations in (instrumental) activities of daily living ((I)ADLs), which may resu...

Background According to the principles of Reablement, home care services are meant to be goal-oriented, holistic and person-centred taking into account the capabilities and opportunities of older adults. However, home care services traditionally focus on doing things for older adults rather than with them. To implement Reablement in practice, the ‘...

Reablement aims to empower people to age in place with the highest degree of self-reliance. However, this requires a behavioral change in home care staff who tend to do things for instead of with their clients. Therefore the “Stay Active at Home” program was developed. To explore the experiences of home care staff with the program 21 semi-structure...

Our aging society asks for sustainable long-term care services for older adults. Previous research has shown that active engagement in daily activities contributes to successful aging. However, with increasing age older adults are often in need for outpatient or inpatient services due to functional limitations. In the best case, caregivers adapt th...

Purpose to support older people with several healthcare needs in sustaining adequate functioning and independence, more proactive approaches are needed. This purpose of this study is to summarise the (cost-) effectiveness of proactive, multidisciplinary, integrated care programmes for older people in Dutch primary care. Methods design individual p...

Fee‐for‐service, funding care on an hourly rate basis, creates an incentive for home‐care providers to deliver high amounts of care. Under casemix funding, in contrast, clients are allocated—based on their characteristics—to homogenous, hierarchical groups, which are subsequently funded to promote more effective and efficient care. The first step i...

Background: A fundamental issue in elderly care is targeting those older people at risk and in need of care interventions. Frailty is widely used to capture variations in health risks but there is no general consensus on the conceptualization of frailty. Indeed, there is considerable heterogeneity in the group of older people characterized as frai...

Background: The Older Persons and Informal Caregivers Minimum Data Set (TOPICS-MDS) is a standardized data set that was developed to evaluate the quality of multidimensional geriatric care. There is an inherent need to reduce the number of TOPICS-MDS survey items to core outcomes to allow it to be more easily applied as a patient-reported outcome m...

Aims: The aim of this paper is to describe and discuss the 'Basic Care Revisited' (BCR) research programme, a collaborative initiative that contributes to evidence-based basic nursing care and raises awareness about the importance of basic nursing care activities. Background: While basic nursing care serves nearly all people at some point in the...

Objective: Complex interventions are criticized for being a 'black box', which makes it difficult to determine why they succeed or fail. Recently, nine proactive primary care programmes aiming to prevent functional decline in older adults showed inconclusive effects. The aim of this study was to systematically unravel, compare and synthesize the d...

Background Our ageing society is putting tremendous strain on public health and welfare programs to meet the needs of ageing individuals. Promoting informal caregiving is one way for policymakers to reduce this burden. However, caregiving may be experienced as stressful and is associated with adverse health consequences. While quite a lot of resear...